بررسي اثرات بيسموت درماني بر روي كارايي رژيم دارويي در ريشه كن كردن هليكوباكتر پيلوري

STUDY OF THE EFFECT OF PRIOR ADMINISTRATION OF BISMUTH ON THE EFFICACY OF QUADRUPLE DRUG THERAPY FOR ERRADI CA TION OF HELI COBACTER PYLORI IN DEODENAL ULCER PATIENTS

2 weeks of quadruple therapy containing Omeprazole or Ranitidine plus Bismuth and two antibiotics (Metronidazole or Clarithromycin and Amoxicillin ) has a low cure rate of HP infection in Iranian DU patients . Bismuth compounds have a powerful bactericidal effect causing structural vacuolation and degradation of HP in humans. The aim of this study was to evaluate the efficacy of one week administration of Bismuth compounds before starting quadruple therapy . DU patients with positive urease test were randomly allocated to two groups (Gr); Gr I received bismuth subcitrate 3x120 mg/day given alone for one week with continuation of the same therapy in combination with Omeprazole 2x20mg , Metronidazole 2 x 500 mg and Tetracycline 2 x 500 mg daily for 2 weeks . Gr 11 received the same therapy as in Gr I without previous Bismuth therapy . Control endoscopy was performed 4 weeks after the end of therapy . 3 specimens from antrum and 3 from corpus mucosa were obtained for urease test and histology . HP cure was assumed if all tests were negative . Between Oct 97 and Oct 2000 , 262 patient were entered (131 in each Gr) .122 patients in Gr 1 and 120 patients in Gr 11 completed the study . Ulcer healing rate was 94.2% in Gr I and 91.6% in Gr II . The per protocol cure rate of HP infection was 91% in Gr I (95% CI :86-96%) and 78.3% in Cr II (95% CI 69- 85%) (p< 0.01) .The cure rate by ITT analysis was 81.1% in Gr 1(95% CI : 78 - 90%) and 71.7% in Gr I1 (95% CI : 64-78%) (p<0.025) . Although 17% of patients in Gr 1 and 15% in Gr II had nausea as the most frequent side effect , all patients tolerated the regimen with no interruption. It is therefore concluded that previous administration of bismuth compound alone for one week before starting eradication regimen increases the cure rate of HP infection . In resistant HP strains , sequential administration of drugs should be considered as an effective treatment modality for HP infection .